Neonatal Medicine

  • 제18권2호
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  • Pages.204-210
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  • 2011
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  • 2287-9412(pISSN)
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  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
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극소 저체중 출생아에서 식이 불내성을 임상적 특징으로 하는 알레르기성 장염

Feeding Introlerance Due to Allergic Enterocolitis in Very Low Birth Weight Infants

  • 고유미 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 김진규 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 안소윤 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 유혜수 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 전가원 (인제대학교 의과대학 부산백병원 소아과학교실) ;
  • 김은선 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아청소년과학교실)
  • Ko, Yu-Mi (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jin-Kyu (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, So-Yoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Hye-Soo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeon, Ga-Won (Department of Pediatrics, Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Eun-Sun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun-Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won-Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2011.11.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 극소 저체중 출생아에서 식이 불내성은 매우 흔하나, 괴사성 장염 외에는 원인에 대한 연구가 미흡하다. 본 연구기관에서는 식이 불내성이 지속되는 극소 저체중 출생아 중 알레르기성 장염을 의심하여 치료한 경험이 있어 이의 임상상을 분석하고자 하였다. 방법: 2009년 1월부터 2010년 7월까지 삼성서울병원 신생아 중환자실에 입원하였던 출생 체중 1,500 g 미만의 미숙아들 중에 식이 불내성을 보이고, 말초혈액 검사상 중등도 이상의 호산구증(${\geq}$1,000 cells/$mm^3$)이 동반되는 경우에 신생아 괴사성 장염이 배제된 상태에서 식이 제한 모유 혹은 가수 분해 분유에 반응하였던 경우들을 조사하였다. 결과: 연구대상 181명 중에서 식이 불내성을 나타낸 환자는 총 161명(88.9%), 호산구 증가증을 나타낸 환자는 119명(65.7%), 중등도 이상의 호산구 증가증을 나타낸 환자는 85명으로 47%의 유병률을 보였다. 알레르기성 장염으로 진단받은 환자는 17명으로 9.4%의 유병률을 보였다. 식이 불내성 환자 중 알레르기성 장염군(n=17)과 비알레르기성 장염군(n=144)과의 비교에서 평균 재태 주수, 출생 체중, 입원 기간, 항생제 사용 기간, 증상 발생일, 정맥 영양 기간은 차이가 없었으나, 최대 호산구 %의 평균값은 두 질환군에서 통계학적으로 유의하게 차이가 있었다. 알레르기성 장염으로 진단 받은 환자들 중 식이 제한모유로 2명인 12%에서 증상의 호전을 보였고, Extensively hydrolyzed formula로 10명(59%)에서 증상의 호전을 보였다. Free amino acid-based formula로 5명(29%)에서 증상의 호전을 보였다. 결론: 극소 저체중 출생아에서 식이 불내성이 있는 경우 알레르기성 장염의 가능성을 고려할 수 있고 이 경우 식이 변경을 통해 적극적인 식이 진행이 가능하였다.

Purpose: Feeding intolerance is common in very low birth weight infants(VLBWI); however, research on the etiology is limited. We investigated the incidence of allergic enterocolitis (AEC) as a cause of feeding intolerance and present the clinical characteristics of VLBWIs. Methods: The medical records of VLBWIs admitted to the neonatal intensive care unit of Samsung Medical Center between January 2009 and July 2010 were retrospectively analyzed. AEC was defined as patients who had feeding intolerance with eosinophila and who responded to hypoallergenic feeding intervention. Feeding intolerance symptoms included blood tinged stools, abdominal distension, residual feeding and regurgitation. Eosinophilia was defined as an eosinophil count ${\geq}$700 cells/$mm^3$. Patients with feeding intolerance were divided into the AEC or non-AEC group. Results: Of the 181 patients, 161 (88.9%) had a feeding intolerance, and 119 (65.7%) had eosinophilia. Seventeen infants were diagnosed with AEC. No difference in mean gestational age, birth weight, antibiotics duration, TPN duration, hospitalization, or symptom onset day was observed between patients with AEC and non-AEC patients. The percentage of eosinophilia was significantly higher in patients with AEC than in non-AEC patients. Two patients (12%) improved with restricted breast milk, 10 patients (59%) with extensively hydrolyzed formula and five patients (29%) with free amino acid-based formula. Conclusion: Our results suggest that AEC should be considered in VLBWIs who have clinical features of feeding intolerance and eosinophilia. An aggressive increase in feeding would be possible through feeding intervention in VLBWIs with feeding intolerance.

키워드

참고문헌

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피인용 문헌

  1. Three Cases of Preterm Infants Showing Pneumatosis Intestinalis without Progression to Typical Necrotizing Enterocolitis vol.21, pp.3, 2011, https://doi.org/10.5385/nm.2014.21.3.192
  2. Clinical Findings According to Feeding Diets in Very Low Birth Weight Infants: Human Breast Milk versus Bovine Milk-Based Formula vol.23, pp.1, 2011, https://doi.org/10.5385/nm.2016.23.1.23